Deep plane SMAS - how does the SMAS get reattached?

You are correct that the main fixation for the SMAS flap is sutures, which are fixed to the same SMAS at a higher level. Some surgeons place a lot of sutures that hold the SMAS in an elevated and tightened position and some use two layers of sutures. The sutures are the initial fixation, but over time the SMAS flap heals and scars into position and that is what holds it in place as the sutures, dissolve and disappear. This healing is usually complete 4 to 6 weeks and afterwords facial massages should not be a problem. Best wishes.

Hi, thank you for your question regarding how the SMAS is reattached in a deep plane facelift. Most plastic surgeons use permanent suture to reattach the SMAS, employing multiple different positions and vectors where the sutures are placed. Usually, the permanent sutures are placed in both a horizontal and vertical plane, although some plastic surgeons advocate for an oblique plane. Typically, the SMAS is attached to itself. Some plastic surgeons remove a layer of the SMAS, and the edges of the SMAS are attached. When the SMAS is reattached to itself, the tissues bunch in the area underneath the attachment. This leads to augmentation in that area, which is beneficial for cheek or malar augmentation. Facial massaging will not disrupt these permanent sutures, as they are strong and durable. However, facial massages should be avoided for at least the first two months to ensure optimal healing. I hope this helps answer your question about how the SMAS is reattached after a deep plane facelift. Good luck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Thank you for your question. It is indeed an aspect that benefits from more detailed explanations in particular when people think about how to best look after themselves in the post operative phase.
The principal, behind the surgery is to release some of the ligaments that stabilise the SMAS and skin to allow better redraping of the facial tissues.
As such, it is often not necessary to use significant tension during the surgery. After the surgery, swelling of the soft tissues, and even limited amount of bleeding increases the volume and therefore creates the impression that there is more tension used by the surgeon to lift and support the SMAS.
The stitches for support of the facelift are anchored to the area of the cheek, which is in front of the ear and is also referred to as the fixed SMAS, as opposed to the mobile SMAS situated further forward. The descriptive name comes from the fact that in that region, the SMAS has strong attachments to the underlying and will not be displaced forward by the suspension sutures.
The area of suspension covers the whole height of the cheek.
Detaching the SMAS is unlikely, but I always advise patients to either have manual lymphatic drainage with a specialist or to do gentle massage, upward, and backward in line with the direction of the lift, and to avoid pushing the facial tissues down.